It appears my loved one is need of surgery. He has stenosis of the spine in several places, resulting in weakness and mobility issues in arms, legs, and hands. PT , which has been on going has helped with some additional mobility and strength, but very minimal.
Currently in a nursing home, as he is unable to stand, walk, transfer without the help of two people or hoyer lift.
Currently private pay , but funds are nearly exhausted.
HELP
I am grateful to have found it and hope I can pay it forward with a reply that helps someone else.
He currently is not on community Medicaid, ( income) or Medicare , ( age)
Recently deemed disabled by SS, but waiting period for Medicare 9 mo away
planning to apply for Medicaid , to cover the nursing care / living costs. Currently has private insurance which has been paying for tests, and Dr visits.
I am not sure what his insurance will pay if he needs surgery (s).
problem is costs long term so Medicaid in nursing home seems only option.
He has pension so we would turn over to nursing home
And if it couldn't make much difference... why would you put him through it?
I haven't been to check what Medicaid in IL says about it, mind, but that shouldn't be difficult to do.
"Primary services funded through Medicaid are physician, hospital and long term care. Additional coverage includes drugs, medical equipment and transportation, family planning, laboratory tests, x-rays and other medical services." Which I guess includes surgery.
Other documents discuss the need for a proposed treatment to be "medically necessary" (so I should hope).
And, of course, your LO would have to qualify for Medicaid. Have you been to the site to see if he's eligible? There's a checker function on this page: https://www.benefits.gov/benefit/1628
Sorry, starting again.
His income is too high for him to qualify for Medicaid.
But not too high for him to qualify for ltc through Medicaid as a person with a disability.
He is (just) too young to qualify for Medicare as a senior.
He currently has health insurance - with whom? Have you asked them if they'd cover the proposed surgery?
If the surgery were successful, would he be hoping not to need a nursing home? How long has he been there? What happened?
I wouldn't wait for the surgery if he has insurance now and the prognosis is good for recovery. Do your research and get a 2nd or 3rd opinion. My husband had 15 doctors telling him no surgery, the odds of him being worse were higher than the odds of him getting any better. Then the insurance company says they need an independent medical exam. Oh yeah, I can operate and it's all good. Really? We saw world renown doctors and they said no way and here you are needing what a new Mercedes or did the insurance offer a bonus to cut him open and completely cripple him. Get a firm understanding of what his prognosis with surgery would be.
I would also question whether this will create a degenerative issue where the vertebrae next to the surgical site will start to fail, common, and what range of motion and mobility can he expect worse case and best case.
I hope he can have the surgery and go on to live life outside of a NH.